376 Strangles. 



mucous membranes is manifested by the ordinary symptoms; 

 tlie nasal catarrh is sometimes very mild, but the mucous 

 membrane may secrete a profuse purulent discharge, while 

 suppurative inflammation of the lymph glands does not take 

 place. 



The inflammation of the lymph glands does not in all cases 

 lead to suppuration and abscess formation. Especially in older 

 horses the swelling of the lymph glands may come to a stop 

 at a certain time, whereupon it gradually retrogresses, and 

 finally disappears entirely, only a slight thickening remaining 

 in some cases. 



More important are those complications which result from 

 the extension of the inflammatory process to the immediate 

 surroundings, or to metastatic processes. 



The inflammatory process extends most frequently to the 

 region of the pharynx, which then, together with the subparotid 

 glands, and the laryngeal region,, swells to a high degree. The 

 swelling is usually caused by an inflammatory edema of the 

 subcutaneous connective tissue, which results from severe in- 

 flammation of the submaxillary lymph glands. 



Unfavorable significance attaches to cases in which pharyn- 

 gitis becomes associated with purulent inflammation of the 

 retropharyngeal lymph glands. In such instances the swelling 

 always attains a very high degree, and is either uniformly 

 distributed on both sides, or more marked on one side. At 

 the same time symptoms of severe pharyngitis are present. 

 Excluding the regurgitation caused by the serous infiltration 

 of the pharyngeal muscles, swallowing is rendered difficult or 

 even impossible, by a marked extension of the posterior wall 

 of the pharynx. Besides this, the larynx may be forced down- 

 wards and forwards by the swelling and thereby cause inspira- 

 tory dyspnea and stenosis. Finally the suppurating abscesses 

 in the pharyngeal wall may burst in any direction. This occurs 

 most easily into the pharyngeal cavity, especially when the 

 mucous membrane is necrotic in places. In such cases a great 

 quantity of pus is suddenly evacuated by the mouth and nose, 

 and then it is always possible that the suddenly eliminated pus 

 may be aspirated through the laryngeal opening into the deeper 

 air passages. In other cases the suppurative process pene- 

 trates to the outside, and finally reaches the lower parotid 

 region, or the vicinity of the larynx under the skin; after the 

 perforation of this part the pus is evacuated outside. Ex- 

 ceptionally the perforation may take place both to the outside 

 and inside, which leads to the formation of a pharyngeal fistula, 

 the healing of which usually requires a long time. The condition 

 becomes still more aggravated in case the inflammation extends 

 to the soft palate, or downwards and forwards to the muscles 

 of the hyoid bone (muse, omohyoideus and muse, hyoideus), in 

 which cases swallowing is impossible and the danger of an 

 inhalation pneumonia becomes greater. The catarrh of the 



